Evidence for 24-hour posture management: A scoping review

© The Author(s) 2023. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/Introduction:: People with complex physical disabilities unable to change their position independently are at risk of developing postural deformities and secondary complications. 24-hour posture management is needed to protect body structure. With inconsistencies in current service provision, this research aimed to scope the evidence for a 24-hour posture management approach. Method:: A scoping review was conducted using four health and social science databases. Inclusion and exclusion criteria were applied; further papers were included through citation chaining. Results:: The evidence for 24-hour posture management was often low quality due to the complications of completing robust research studies in this complex specialty. However, many professionals in the field agree that a 24-hour approach to postural care is essential. Conclusion:: There is a need for clear national policy and guidance relating to postural care and scope for development of dedicated posture management services. Current NHS service provision is variable and inconsistent. Lack of postural care is a safeguarding and human rights issue. Specialist training and research in postural care within the Occupational Therapy profession is required to raise awareness of the role Occupational Therapists can play in preventing postural deformities and other secondary complications through providing good postural care.Peer reviewe

 EARLY BOMB RADIOCARBON DETECTED IN PALAU ARCHIPELAGO CORALS

In order to evaluate the variability in surface water masses in the western Pacific warm pool, we report high-precision radiocarbon measurements in annual and seasonal bands from Porites lutea corals collected from the Palau Archipelago (7°N, 134°E). Annual coral bands from 1945 to 2008 and seasonal samples from 1953 to 1957 were analyzed to capture the initial early input of bomb 14C from surface thermonuclear weapons testing in the Marshall Islands. Results show a pre-bomb average Δ14C value of –54.9‰ between 1945 and early 1953. Beginning early in 1954, there is a rapid increase to a maximum of –23.1‰ at the start of 1955. Values continued to rise after 1957 to a post-bomb peak of 141‰ by 1976. The large initial rise in Δ14C cannot be accounted for by air-sea CO2 exchange. Results therefore suggest that the primary cause of this increase is the lateral advection of fallout-contaminated water from the Marshall Islands to Palau via the North Equatorial Current and then to the North Equatorial Countercurrent

The Ursinus Weekly, April 27, 1953

Y to sponsor panel meeting with Albright • Price, Merrifield, Haines, Hartman to head WSGA, WAA, YWCA, YMCA • May Day dancers prepare pageant for gala weekend • Concert presented by Meistersingers • Fraternities plan May dinner dances • Sororities make plans for shore visits, dinner dances • Group plays to be given • Eight win full scholarships • French teachers\u27 conference held at Ursinus, April 25 • Thespians to give Two blind mice • Friedlin crowned queen; Cub & Key honors five • Radomski, Wong elected to pre-med society offices • Class and council petitioning ends Friday • Jones reads from works of Noyes and Lindsay on Tuesday • Editorials: Tradition vs. common sense • I love Spring! • Helfferich named to board • Career offer for grads • Letters to the editor • Are you wasting money? • Alumni news • U.C. co-ed gives inside scoop on life in a boys\u27 dormitory • Ursinus professors are authorities in subject fields • From memoirs of a freshman: A visit to the Supply Store • Bears drop track meet to West Chester, 69-57 • Bryn Mawr tops girls in tennis • Baseball team loses, 8-7; But tops Graterford, 7-3 • East Stroudsburg routs Belles, 5-0 • Men\u27s tennis team loses, 5-4 • Belles, Albright vie in softball opener • Court squad downs Chestnut Hill, 5-0 • Hutch twirls shut-out; Bears beat Pharmacy, 20-0https://digitalcommons.ursinus.edu/weekly/1518/thumbnail.jp

Biomarkers characterization of circulating tumour cells in breast cancer patients

Introduction: Increasing evidence supports the view that the detection of circulating tumor cells (CTCs) predicts outcomes of nonmetastatic breast cancer patients. CTCs differ genetically from the primary tumor and may contribute to variations in prognosis and response to therapy. As we start to understand more about the biology of CTCs, we can begin to address how best to treat this form of disease. Methods: Ninety-eight nonmetastatic breast cancer patients were included in this study. CTCs were isolated by immunomagnetic techniques using magnetic beads labelled with a multi-CK-specific antibody (CK3-11D5) and CTC detection through immunocytochemical methods. Estrogen receptor, progesterone receptor and epidermal growth factor receptor (EGFR) were evaluated by immunofluorescence experiments and HER2 and TOP2A by fluorescence in situ hybridization. We aimed to characterize this set of biomarkers in CTCs and correlate it with clinical-pathological characteristics. Results: Baseline detection rate was 46.9% ≥ 1 CTC/30 ml threshold. CTC-positive cells were more frequent in HER2-negative tumors (p = 0.046). In patients younger than 50 years old, HER2-amplified and G1-G2 tumors had a higher possibility of being nondetectable CTCs. Heterogeneous expression of hormonal receptors (HRs) in samples from the same patients was found. Discordances between HR expression, HER2 and TOP2A status in CTCs and their primary tumor were found in the sequential blood samples. Less that 35% of patients switched their CTC status after receiving chemotherapy. EGFR-positive CTCs were associated with Luminal tumors (p = 0.03). Conclusions: This is the largest exploratory CTC biomarker analysis in nonmetastatic BC patients. Our study suggests that CTC biomarkers profiles might be useful as a surrogate marker for therapeutic selection and monitoring since heterogeneity of the biomarker distribution in CTCs and the lack of correlation with the primary tumor biomarker status were found. Further exploration of the association between EGFR-positive CTCs and Luminal tumors is warranted

Clinically-indicated replacement versus routine replacement of peripheral venous catheters (Review)

Background: US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. This is an update of a review first published in 2010. Objectives: To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re-siting the catheter routinely. Search methods: For this update the Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Vascular Specialised Register (March 2015) and CENTRAL (2015, Issue 3). We also searched clinical trials registries (April 2015). Selection criteria: Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions. Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Main results: Seven trials with a total of 4895 patients were included in the review. The quality of the evidence was high for most outcomes but was downgraded to moderate for the outcome catheter-related bloodstream infection (CRBSI). The downgrade was due to wide confidence intervals, which created a high level of uncertainty around the effect estimate. CRBSI was assessed in five trials (4806 patients). There was no significant between group difference in the CRBSI rate (clinically-indicated 1/2365; routine change 2/2441). The risk ratio (RR) was 0.61 (95% CI 0.08 to 4.68; P = 0.64). No difference in phlebitis rates was found whether catheters were changed according to clinical indications or routinely (clinically-indicated 186/2365; 3-day change 166/2441; RR 1.14, 95% CI 0.93 to 1.39). This result was unaffected by whether infusion through the catheter was continuous or intermittent. We also analysed the data by number of device days and again no differences between groups were observed (RR 1.03, 95% CI 0.84 to 1.27; P = 0.75). One trial assessed all-cause bloodstream infection. There was no difference in this outcome between the two groups (clinically-indicated 4/1593 (0.02%); routine change 9/1690 (0.05%); P = 0.21). Cannulation costs were lower by approximately AUD 7.00 in the clinically-indicated group (mean difference (MD) -6.96, 95% CI -9.05 to -4.86; P ≤ 0.00001). Authors' conclusions: The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present

Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]

Background US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. This is an update of a review first published in 2010. Objectives To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re‐siting the catheter routinely. Search methods For this update the Cochrane Peripheral Vascular Diseases (PVD) Group Trials Search Co‐ordinator searched the PVD Specialised Register (December 2012) and CENTRAL (2012, Issue 11). We also searched MEDLINE (last searched October 2012) and clinical trials registries. Selection criteria Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Seven trials with a total of 4895 patients were included in the review. Catheter‐related bloodstream infection (CRBSI) was assessed in five trials (4806 patients). There was no significant between group difference in the CRBSI rate (clinically‐indicated 1/2365; routine change 2/2441). The risk ratio (RR) was 0.61 but the confidence interval (CI) was wide, creating uncertainty around the estimate (95% CI 0.08 to 4.68; P = 0.64). No difference in phlebitis rates was found whether catheters were changed according to clinical indications or routinely (clinically‐indicated 186/2365; 3‐day change 166/2441; RR 1.14, 95% CI 0.93 to 1.39). This result was unaffected by whether infusion through the catheter was continuous or intermittent. We also analysed the data by number of device days and again no differences between groups were observed (RR 1.03, 95% CI 0.84 to 1.27; P = 0.75). One trial assessed all‐cause bloodstream infection. There was no difference in this outcome between the two groups (clinically‐indicated 4/1593 (0.02%); routine change 9/1690 (0.05%); P = 0.21). Cannulation costs were lower by approximately AUD 7.00 in the clinically‐indicated group (mean difference (MD) ‐6.96, 95% CI ‐9.05 to ‐4.86; P ≤ 0.00001). Authors' conclusions The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re‐sites in the absence of clinical indications. To minimise peripheral catheter‐related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present